DRVA2015-0002oj!' uLda., See below for Finance Revenue Codes
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking.lots, sewers, water mains and other like public
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 3/11/2015
LOCATION OF CONSTRUCTION(Street address or Description): 78695 AVENIDA LA FONDA
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGINIiZ TIME OF COMPLETION:
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS:
In consideration of the granting of this permit, the applicant 'hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four 4) hours in advance of the time when work will be started
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules andJ,uItions of
to pay for any additional replacement necessary as the result of this work. // J (
of Applicant or Agent
A.P. & VERNA LENCH 78-215 CALLE CADIZ LA'QUINTA, CA 92253
Name of Applicant (please print) Business Address Telephone No.
OWNER /BUILDER
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
Policy Number
PERMIT NO:
DATE lSSUED:Llo t is
E 7P XPIR _ZIATE, "10 1 (O
Y
14R
WORK INSPECTED BY*:
PERMIT COMPLETION DATE*:
1AR 11 2015
- CITY OF LA QIJINTA
COMMUNITY DEVELOPMENT DEPARTMENT
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
See below for Finance Revenue Codes
it ft/ 01' .4z
fJ
ENCROACHMENT PERMIT
OF
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 3/11/2015
LOCATION OF CONSTRUCTION(Street address or Description): 78695 AVENIDA LA FONDA
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: TIME OF COMPLETION:
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS:
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
A.P. & VERNA LENCH 78-215 CALLE CADIZ LA QUINTA, CA 92253
Name of Applicant (please print) Business Address
OWNER /BUILDER
Name of Contractor and Job Foreman Business Address
Contractor's License No.
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
Telephone No.
Telephone No.
City Business License No.
Policy Number
PERMIT NO: DRVA2015-0002
DATE ISSUED:
EXPIRATION DATE:
BY:
WORK INSPECTED BY*:
PERMIT COMPLETION DATE:
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
a
A.
%OF DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please pjjt name here): 1A.P. & VERNA LENCH Dui n& r
If
178-215 IICALLECADIZ 1LAQUINTA UCA 1192253 I
Number Street City State Zip Code
_ 's address above: Address or Parc t.werk location, if dife.jent from applicant ____________________ F — q1 78-695AVENIDALAFoND 2 T[AQUINTA 1ICA 1192253
Number City State Zip Code
Date: [ö1/iTh/J2015j Applicant's Phone No: (760 ) 1578-1077
Applicant's Signature:
Approximate Start Date: 103 1/11 1i15 1Approximate Completion Date: 103 1/:18 11:15
Contractor Information:
Address:
-----~JP 0 BOX 1018 JTHOUSAND PALMS JICA 1 192276 —1
Number Street City State Zip Code
Phone Number: (1760 1343-5272 lContractors License Number: 1845115
City Business License Number:
General Liability Insurance Company: ROSTEN INS AGENCY Policy No. 1125073
Request for Inspection -EPèse call (760) 777-7097)e fore 1:30pm to request an inspection at least 24
hours prior to your requesteffihsp-ecuon uate. FuoucWorks Counter (760) 777-7075.
Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm
Permit No. Expiration Date
Permit Issued by: Date Issued=/fl/l j
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: Il/jl J
Inspector's Signature
Note: Driveway approach must be constructed per City of La Quinta Standard #221
p